Retinal and Choroidal Thickness in an Indigenous Population from Ghana: Comparison with Individuals with European or African Ancestry

Purpose

To evaluate the thickness of the macular retina and central choroid in an indigenous population from Ghana, Africa and to compare them with those measured among individuals with European or African ancestry.

Design

Cross-sectional study, systematic review, and meta-analyses.

Participants

Forty-two healthy Ghanaians, 37 healthy individuals with European ancestry, and an additional 1427 healthy subjects with African ancestry from previously published studies.

Methods

Macular retinal thickness in the fovea, parafovea, and perifovea and central choroidal thickness were extracted from OCT volume scans. Associations with ethnicity, age, and sex were assessed using mixed-effect regression models. Monte Carlo simulations were performed to determine the sensitivity of significant associations to additional potential confounders. Pooled estimates of retinal thickness among other groups with African ancestry were generated through systematic review and meta-analyses.

Main Outcome Measures

Macular retinal thickness and central choroidal thickness and their association with ethnicity, age, and sex.

Results

When adjusted for age and sex, the macular retina and central choroid of Ghanaians are significantly thinner as compared with subjects with European ancestry (P < 0.001). A reduction in retinal and choroidal thickness is observed with age, although this effect is independent of ethnicity. Meta-analyses indicate that retinal thickness among Ghanaians differs markedly from that of African Americans and other previously reported indigenous African populations.

Conclusions

The thickness of the retina among Ghanaians differs not only from those measured among individuals with European ancestry, but also from those obtained from African Americans. Normative retinal and choroidal parameters determined among individuals with African or European ancestry may not be sufficient to describe indigenous African populations.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Ethnic Differences in the Effects of Five Disciplinary Techniques on Subsequent Externalizing Behavior Problems

To identify disciplinary alternatives to replace spanking, this study investigated ethnic differences in the associations of five disciplinary techniques with subsequent externalizing behavior problems in a national sample of 7- to 11-year-olds with ANCOVAs and difference-score analyses. Most techniques led to significant reductions in externalizing problems for African-Americans or Hispanics, but only after overcoming known biases in ANCOVA and not for other European-Americans. Privilege removal had the most significantly effective results, followed by grounding. Sending children to their room and spanking significantly reduced externalizing problems only in one or two analyses for African-Americans, whereas removing children's allowance was significantly effective in one overall analysis. Parenting research needs to distinguish between more vs. less effective use of all disciplinary techniques across multiple situational and cultural contexts.

Barber-Led HIV/Sexually Transmitted Infection Risk Reduction for Young African-American Men: Efficacy and Mediation in a Cluster Randomized Controlled Trial

PURPOSE

The aim of this study is to evaluate the efficacy and mediation of a culturally appropriate, theory-based HIV/STI (sexually transmitted infection) risk-reduction intervention delivered in barbershops by barbers via iPads to African-American young men in reducing sexual risk behaviors.

METHODS

In a cluster randomized controlled trial, 24 matched pairs of barbershops serving African-American men ages 18-24 in the 10 Philadelphia, PA zip codes with the highest HIV/AIDS prevalence were randomized to implement via iPads one of 2 interventions: "Shape Up! Barbers Building Better Brothers," an HIV/STI risk-reduction intervention based on the theory of planned behavior and formative research or an attention-matched violence-prevention control intervention. The primary outcome was self-reported consistent condom use 3, 6, and 12 months postintervention, controlling for baseline consistent condom use.

RESULTS

Participants were 618 men, 319 in the HIV/STI intervention and 299 in the control intervention. Generalized estimating equation analysis indicated that the direct effect of the HIV/STI intervention in increasing consistent condom use postintervention was nonsignificant (odds ratio = 1.13, 95% confidence interval: 0.73-1.75), adjusting for clustering among participants in barbershops and baseline condom use. However, mediation analysis using the product-of-coefficients approach revealed indirect effects of the intervention. Consistent with the theory of planned behavior, the intervention increased behavioral beliefs and self-efficacy regarding using condoms, which raised condom use intention, which, in turn, boosted consistent condom use.

DISCUSSION

Sexual risks among young African-American men can be reduced by barber-led theory-based, culturally appropriate HIV/STI risk-reduction interventions in barbershops in high HIV prevalence neighborhoods that increase behavioral beliefs and self-efficacy.

A Protected Class, An Unprotected Condition, and A Biomarker - A Method/Formula for Increased Diversity in Clinical Trials for the African American Subject with Benign Ethnic Neutropenia (BEN)

Expanding on previous industry guidance relative to increased clinical trial diversity, while honing more exacting treatments and better ways to fight diseases that have often disproportionately impacted people of color, is a topic being discussed by multidisciplinary public health experts across the nation.This writing draws attention to the African American demographic, which is continually subject to health care disparities. Any glimpses of knowledge or medical discovery that could potentially help to redress harm or reinforce a weakened familial-cultural infrastructure should be emphasized for sanative restoration of the impacted communities. The focus of this writing is the African American cohort and its nexus to Benign Ethnic Neutropenia as the diverse target population of discussion, hoping to convey a harmonized approach in the examination of (1) the African American Benign Ethnic Neutropenia cohort within the context of basic scientific understanding, (2) the interplay of applicable governing regulatory protections, and (3) increased clinical trial participation to enlarge the pathway for increased diversity in clinical trials.

Measuring copeptin, a surrogate for vasopressin in patients with hypertension - Can it identify those who are volume Responsive?

BACKGROUND

Among hypertensive patients, plasma renin activity is lower and the response to diuretic monotherapy greater in volume responsive hypertensive patients. We hypothesized that hormones influencing extracellular volume such as vasopressin / antidiuretic hormone (ADH) might permit the development of a simple test to identify those with volume-related hypertension. Such a test might be of particular benefit to the Black population which is purported to have a higher incidence of volume-related and responsive hypertension. Thus, using copeptin, a surrogate marker for ADH, we studied if there were differences in this hormone between those with and without volume responsive hypertension.

METHODS

Serum copeptin was measured in biobanked blood samples from the Genetic Epidemiology of Responses to Antihypertensives (GERA) I study and analyzed with other variables from the study dataset.

RESULTS

There was no relationship between PRA and copeptin values nor could the response in blood pressure be predicted by the copeptin values. However, baseline copeptin levels were higher in Black than in White subjects (7.5 pmol/L vs 5.4 pmol/L, P < 0.001) while plasma sodium and calculated plasma osmolality were slightly lower in keeping with the concept that Black subjects have more volume-related hypertension. In addition, after hydrochlorothiazide (HCTZ), copeptin was significantly lower in Black (6.2 pmol/L, P = 0.004) but unchanged in White subjects (5.2 pmol/L, P = 0.901) and there were also changes in sodium.

CONCLUSION

The current study suggests differences in ADH physiology between hypertensive Black and White patients. However, the use of copeptin to identify volume responsive patients could not be confirmed.

Use of a focus group-based cognitive interview methodology to validate a cooking behavior survey among African-American adults

Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent's interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults (n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants' perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents-specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking.

SMOC2 gene interacts with APOL1 in the development of end-stage kidney disease: A genome-wide association study

Background

Some but not all African-Americans (AA) who carry APOL1 nephropathy risk variants (APOL1) develop kidney failure (end-stage kidney disease, ESKD). To identify genetic modifiers, we assessed gene-gene interactions in a large prospective cohort of the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Methods

Genotypes from 8,074 AA participants were obtained from Illumina Infinium Multi-Ethnic AMR/AFR Extended BeadChip. We compared 388 incident ESKD cases with 7,686 non-ESKD controls, using a two-locus interaction approach. Logistic regression was used to examine the effect of APOL1 risk status (using recessive and additive models), single nucleotide polymorphism (SNP), and APOL1^*SNP interaction on incident ESKD, adjusting for age, sex, and ancestry. APOL1 ^*SNP interactions that met the threshold of 1.0 × 10^-5 were replicated in the Genetics of Hypertension Associated Treatment (GenHAT) study (626 ESKD cases and 6,165 controls). In a sensitivity analysis, models were additionally adjusted for diabetes status. We conducted additional replication in the BioVU study.

Results

Two APOL1 risk alleles prevalence (recessive model) was similar in the REGARDS and GenHAT studies. Only one APOL1-SNP interaction, for rs7067944 on chromosome 10, ~10 KB from the PCAT5 gene met the genome-wide statistical threshold (P _interaction = 3.4 × 10^-8), but this interaction was not replicated in the GenHAT study. Among other relevant top findings (with P _interaction < 1.0 × 10^-5), a variant (rs2181251) near SMOC2 on chromosome six interacted with APOL1 risk status (additive) on ESKD outcomes (REGARDS study, P _interaction =5.3 × 10^-6) but the association was not replicated (GenHAT study, P _interaction = 0.07, BioVU study, P _interaction = 0.53). The association with the locus near SMOC2 persisted further in stratified analyses. Among those who inherited ≥1 alternate allele of rs2181251, APOL1 was associated with an increased risk of incident ESKD (OR [95%CI] = 2.27[1.53, 3.37]) but APOL1 was not associated with ESKD in the absence of the alternate allele (OR [95%CI] = 1.34[0.96, 1.85]) in the REGARDS study. The associations were consistent after adjusting for diabetes.

Conclusion

In a large genome-wide association study of AAs, a locus SMOC2 exhibited a significant interaction with the APOL1 locus. SMOC2 contributes to the progression of fibrosis after kidney injury and the interaction with APOL1 variants may contribute to an explanation for why only some APOLI high-risk individuals develop ESKD.

New Onset Poststroke Dementia at one Year in Africans

BACKGROUND

There is limited information on new onset poststroke dementia (NPSD) in sub-Saharan Africa (SSA). We estimated incidence, cumulative incidence, risk factors and outcome of NPSD at 1 year in Nigerian survivors of a first-ever stroke.

METHODS

Hospital-based prospective observational study. Assessments for global cognition, learning, memory, executive and activities of daily life (ADL) functioning were conducted at 3 poststroke timepoints (Baseline, 3- and 12 months). NPSD was ascertained according to the "National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria." Outcomes were assessed using the modified Rankin Scale (mRS), center for epidemiologic studies depression scale (CES-D 10), health related quality of life in stroke patients (HRQOLISP-26) and caregivers strain index (CSI).

RESULTS

Among 144 stroke survivors who were free of dementia at baseline, we found a 1-year cumulative incidence of 4.52% (95% C.I = 3.20, 6.39). In multivariate Cox regression analyses, diabetes was associated with NPSD (Hazard Ratio = 2.10, 95% CI = 1.02, 4.35). NPSD at 3 months was independently associated with motor decline [Mean difference (MD) in mRS = 1.6, 95% C.I = 0.9, 2.3)], depression (MD in CES-D = 2.9, 95% C.I = 0.3, 5.4), caregivers burden (MD in CSI = 1.2, 95% C.I = 0.5, 1.8), and poor quality of life (MD in HRQOLISP-26 = -11.2, 95% C.I = -15.7, -6.8) at 1 year.

CONCLUSION

Approximately 4.5% of stroke survivors in Nigeria had NPSD at 1 year. Diabetes, which can be prevented, represent a primary prevention target for NPSD and its consequences in SSA.

Can African-Americans Be Encouraged to Become Active Participants in Advanced Care Planning?

The purpose of this study was to encourage African-Americans to become active participants in advanced care planning through increased education and awareness. A quasi-experimental design was used in two local churches in Leon County. Thirty participants (N = 30) were African-Americans, 18 years of age and older, English speaking, from all socioeconomical levels, and from all educational backgrounds. The annotated 2003 Minnesota Survey was used to develop pre-survey and post-survey questions regarding advanced care planning. A paired t test was used to analyze the pre-survey and post-survey responses. The significant value was < 0.05, thus demonstrating a statistically significant difference in pre- and post-survey responses. The educational intervention on advanced directives indicated that all 30 participants would consider completing some form of advanced directive or discussing end-of-life care planning with either another person, a healthcare provider, or they would seek legal advice. African-Americans are more prone to chronic diseases. However, a systemic literature review describes how African-Americans were less likely to participate in advanced care planning and were less likely to receive end-of-life care than other ethnic groups. The 30-minute educational intervention encouraged African-Americans to participate in advanced care planning. Because the sample size was small, results cannot be generalized to all African-Americans. With increased educational opportunities, African-Americans may be encouraged to become active participants in advanced care planning. Advanced practice registered nurse providers should provide advanced care planning information to all patients, but especially to African-Americans. This study should be replicated in a wide variety of settings with larger numbers of participants. Further research is needed to discover additional methods of providing advanced care planning education to African-Americans.

COVID-19-related anxiety: How do coping and optimism relate to substance use in African-American young adults?

The COVID-19 pandemic has greatly affected college students nationwide. Recent research suggests that the COVID-19 pandemic has disproportionately impacted African-American young adults. The infection case rates, hospitalizations, and death rates in African-American populations are 2-5 times higher than among White populations. The intergenerational trauma and systemic racism that African-Americans have faced in past and present times have fomented conditions that lead to vulnerability within this historically resilient community. These stresses and losses increase the risks of anxiety and substance use. This study examined the relationship between COVID-19-related anxiety and substance use, and how adaptive coping and optimism influence this relationship in African-Americans young adults. Results reveal that COVID-related anxiety predicts alcohol and drug use. Optimism and adaptive coping are related to lower pandemic-related anxiety, alcohol, and drug use among African-American young adults.

American Indian/Alaska Native, Black, and Hispanic dentists' experiences of discrimination

OBJECTIVE

Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination.

METHODS

This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers' education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination.

RESULTS

Seventy-two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type.

CONCLUSIONS

Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.

Optimism and risk of mortality among African-Americans: The Jackson heart study

Optimism is associated with reduced mortality risk among Whites, but evidence for this relationship is limited among African-Americans, whose life expectancy is shorter than Whites. This study examined the association between optimism and mortality rate in African-Americans. Data were from African-American women (n = 2652) and men (n = 1444) in the United States from the Jackson Heart Study. Optimism was measured using the Life Orientation Test-Revised at the baseline period (2000-2004), and mortality data were obtained until 2018. Using Cox proportional hazards models, we estimated hazard ratios (HRs) of mortality by optimism level, controlling for sociodemographic factors, depressive symptoms, health conditions, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex, age, income, and education. Higher optimism was related to lower mortality rates (HR = 0.85, 95% confidence interval [CI] = 0.74, 0.99), controlling for sociodemographic factors and depressive symptoms. After further adjusting for health conditions and health behaviors, associations were slightly attenuated (HR = 0.89; 95%CI = 0.77, 1.02). Stronger associations between optimism and mortality were observed in men, among those with higher income or education, and with age ≤ 55 (all p's for interaction terms <0.06). In summary, optimism was associated with lower mortality rates among African-Americans in the Jackson Heart Study. Effect modification by sociodemographic factors should be further explored in additional research considering optimism and mortality in diverse populations. Positive factors, such as optimism, may provide important health assets that can complement ongoing public health efforts to reduce health disparities, which have traditionally focused primarily on risk factors.

Black-White Differences in the Reciprocal Relationship Between Perceived Discrimination and Psychological Distress

We formulate a MIDUS longitudinal data-based multi-population LISREL model to gauge variation among Black and White Americans in the reciprocal relationship across time between perceived major and everyday discrimination, and psychological distress. Two hypotheses building on prior theory and empirical findings are generated: reciprocity between perceived discrimination and distress, and stronger reciprocity among Blacks. Here, "reciprocity" denotes positive effects of perceived discrimination and mental health problems such as distress on each other across time. Both hypotheses are supported for relationships between perceived everyday discrimination and distress. The model controls for several potentially relevant variables.

The Impact of African-American Nurses: How the Implementation of a Community-Based Model Increased Vaccination Rates in Marginalized Communities in NYC

The COVID-19 pandemic exposed the inequity and injustice that African-Americans and those in minority communities face when it comes to their fundamental health rights. The prejudice they see in social situations, politics, and finances has resulted in unfair, organized, and socially manufactured health inequities, especially in those minority communities in New York City. These disparities result in a mistrust of the healthcare system and, ultimately, hesitancy toward COVID-19 vaccines. To combat these issues, healthcare leaders such as those from the Greater New York City Black Nurses Association have partnered with community organizations to combat racism in our healthcare system and establish and successfully operate vaccination sites in these communities. These efforts led to the inoculation of over 22,000 people with COVID-19 vaccines. This shows that African-American nurse leaders are best suited to address the healthcare disparities that African-Americans face, especially during public health emergencies, and guide the conversation on racial equity in healthcare.

Structural Barriers Associated with the Intersection of Traumatic Stress and Gun Violence: A Case Example of New Orleans

Gun violence drastically increased in urban cities following the ease of shutdown restrictions associated with the Coronavirus Pandemic. The association of gun violence and COVID-19 has highlighted the importance of taking a public health perspective, particularly as it relates to impacts on the Black community. In this article we discuss macro-level factors and community traumas in the city of New Orleans, an area that has had longstanding issues related to gun violence. Community structural issues, traumatic stress from disasters, and recommendations to address disparities in social determinants of health are discussed.

Predictors of annual prostate-specific antigen (PSA) screening among black men: results from an urban community-based prostate cancer screening program

BACKGROUND AND OBJECTIVE

Black men have an increased risk of prostate cancer mortality compared with any racial or ethnic group. Further, research on prostate cancer prevention and control messaging focusing on Black men is limited. Community screening events are successful in attracting members from high-risk groups, like Black men, and are a valuable source to collect cancer screening and health promotion data. Therefore, the authors examined data of Black men attending a community-based PCa screening event to evaluate predictors of annual PCa screening, and identify sub-populations of Black men needing targeted cancer prevention messaging.

METHODS

Black men attending PCa screening events in St. Louis, MO 2007-2017 were eligible. Participants completed either a mail-in or on-site survey at the time of their screening to collect information on annual screening history. We analyzed sociodemographic factors, having a first-degree relative with a history of PCa, healthcare utilization characteristics, and predictors of annual PSA screening. Logistic regression analysis was used to assess the association between predictors and annual PSA screening.

RESULTS

Data was analyzed from 447 respondents. One-third of the residents did not know their cancer family history status. Older age and having a primary healthcare provider predicted an annual prostate cancer after attending the PCa community screening event. In the fully adjusted model, all ages older than 45 years were 2-4 times more likely to have an annual PCa screening. Having a healthcare provider also predicted an annual PCa screening (OR: 4.59, 95% CI: 2.30-9.14).

CONCLUSION

Regardless of sociodemographic and family history factors, older Black men and those with a primary physician are more likely to have an annual PSA screening. Cancer prevention promotion efforts for Black men should target mechanisms that facilitate family cancer history conversations to engage younger Black men. Also, additional health promotions efforts are needed to educate Black men without a primary healthcare provider.

Preferences for and acceptability of receiving pharmacogenomic results by mail: A focus group study with a primarily African-American cohort

Although genetic counseling is traditionally done through in-person, one-on-one visits, workforce shortages call for efficient result return mechanisms. Studies have shown that telephone and in-person return of cancer genetic results are equivalent for patient outcomes. Few studies have been conducted with other modes, result types or racially diverse participants. This study explored participants' perspectives on receiving pharmacogenomic results by mail. Two experienced moderators facilitated six focus groups with 49 individuals who self-identified primarily as African-American and consented to participate in a genome sequencing cohort study. Participants were given a hypothetical pharmacogenomic result report (positive for c.521T>C in SLCO1B1). An accompanying letter explained that the result was associated with statin intolerance along with a recommendation to share it with one's doctor and immediate relatives. Participants reacted to the idea of receiving this type of result by mail, discussing whether the letter's information was sufficient and what they predicted they would do with the result. Two researchers coded the focus group transcripts and identified themes. Many participants thought that it was appropriate to receive the result through the mail, but some suggested a phone call alerting the recipient to the letter. Others emphasized that although a letter was acceptable for disclosing pharmacogenomic results, it would be insufficient for what they perceived as life-threatening results. Most participants found the content sufficient. Some participants suggested resources about statin intolerance and warning signs be added. Most claimed they would share the result with their doctor, yet few participants offered they would share the result with their relatives. This exploratory study advances the evidence that African-American research participants are receptive to return of certain genetic results by approaches that do not involve direct contact with a genetic counselor and intend to share results with providers. ClinSeq: A Large-Scale Medical Sequencing Clinical Research Pilot Study (NCT00410241).

The Targeted Management (TEAM) Intervention for Reducing Stroke Risk in African American Men: Rationale and Study Design of a Prospective Randomized Controlled Trial

Background

African American (AA) male survivors of strokes or transient ischemic attacks (TIA) have the highest risk of recurrent stroke when compared to other racial-ethnic men. However, there is a paucity of evidence-based strategies, including organizational, educational, or behavioral interventions, that targets secondary stroke risk reduction in AA men.

Methods

Targeted Management for Reducing Stroke Risk (TEAM) is an ongoing, 6-month prospective, randomized controlled trial that will determine whether a curriculum-guided self-management approach, using peer dyads (men who had a stroke or TIA and their care partners) will improve post-stroke care in AA men.

Results

The study sample will consist of 160 AA men who have experienced a stroke or TIA within 5 years, randomized to TEAM or Wait-list control group. The primary outcome changes in systolic blood pressure (BP) and high-density lipoprotein (HDL), while secondary outcomes include diastolic BP, total cholesterol, low-density lipoprotein, triglycerides, and glycemic control for diabetics. We hypothesize that AA men in TEAM will have significantly lower systolic BP and higher HDL when compared to AA men in the Wait-list control group at 6-month.

Conclusion

Persistent disparities for stroke burden in AA men highlight the need for novel interventions to promote secondary stroke-risk reduction. Building on promising pilot data, TEAM uses a group format, with a nurse and patient co-led intervention focused on AA men and family needs, practice in problem-solving, and attention to emotional and role management. In addition, the TEAM approach may help reduce stroke risk factors and health disparities in AA men.

Clinicaltrialsgov Identifier

NCT04402125.

Higher comorbidities and early death in hospitalized African-American patients with Covid-19

Background

African-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions.

Methods

We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a 52-day period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population.

Results

Of the 1103 consecutive patients who tested positive for COVID-19, 529 required hospitalization and were included in the study. 88% of patients were Black; and a majority (52%) were 61–80 years old with a mean body mass index in the “obese” range. 98% had one or more comorbidities. Hypertension was the most common (79%) pre-existing condition followed by diabetes mellitus (56%) and chronic kidney disease (17%). Patients with chronic kidney disease who received hemodialysis were found to have lower mortality, than those who did not receive it, suggesting benefit from hemodialysis Age > 60 years and coronary artery disease were independent predictors of mortality in multivariate analysis. Cox proportional hazards modeling for time to death demonstrated a significantly high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil:lymphocyte ratio (8.3:10.0) were predictive of mortality on admission and at 48–96 h. Of the 529 inpatients 48% died, and one third of them died within the first 3 days of admission. 159/529patients received invasive mechanical ventilation, of which 86% died and of the remaining 370 patients, 30% died.

Conclusions

COVID-19 patients in our predominantly Black neighborhood had higher in-hospital mortality, likely due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-05782-9.

African-Americans Are Less Frequently Assessed For Hereditary Colon Cancer

INTRODUCTION

Colorectal cancer (CRC) is the third most common malignancy in the United States and disproportionately affects African-Americans. Approximately 5-10% of CRC results from hereditary cancer syndromes. A detailed family history is recommended as an initial component of cancer risk assessment to help determine initiation, frequency, screening method and genetic counselling referral. This study evaluated the rate of hereditary CRC risk assessment in African-American and white patients.

METHODS

A chart review of all patients referred for CRC screening in a university gastroenterology clinic during a 3 month period was performed. Patient self-described race/ethnicity, gender, age, documentation of multi-generational family medical history (3+ generations) were obtained. Amsterdam II Criteria, Bethesda Criteria and Colorectal Cancer Risk Assessment Tool were used to determine which patients with family histories should receive referrals for genetic counselling. Statistical analysis was performed using Fisher's Exact Test with significance set at p < 0.05. The study was IRB approved.

RESULTS

872 medical records were reviewed, including 452 African-American (276 females, 176 males; mean age 60.2), 263 White (123 females, 140 males; mean age 59.4), 45 Hispanic, and 42 Asian. Multi-generational family history was obtained from 143 (16.4%); 62 African-American (13.7%; 47 females, 15 males), 58 White (22.1%; 37 females, 21 whites), 3 Hispanic (6.7%), and 4 Asian (9.5%). There was a significant difference (p = 0.0050) in the rate of detailed family history in African-Americans and whites. However, African-Americans and Whites similarly qualified for genetic counselling when family history was obtained (p = 0.7915); 58.1% African-Americans (36; 30 females, 6 males) and 50% Whites (29: 19 females, 10 males) qualified for genetic counselling. Overall referral rate to genetic counselling was 16.5% with no significant difference (p = 0.7586) between African-Americans and whites.

CONCLUSIONS

CRC risk assessment with detailed family medical history was inconsistently performed in all patients. There was significantly lower rate of obtaining multi-generational family medical histories in African-Americans. Referrals of all patients for genetic counselling and testing were also insufficient. Appropriate identification of individuals at increased risk for hereditary cancer syndromes, particularly African-Americans, is critical to prevention, early detection, and treatment of CRC and improving disparities in care.

Racial disparities in knowledge, attitudes and practices related to COVID-19 in the USA

Background

Recent reports indicate racial disparities in the rates of infection and mortality from the 2019 novel coronavirus (coronavirus disease 2019 [COVID-19]). The aim of this study was to determine whether disparities exist in the levels of knowledge, attitudes and practices (KAPs) related to COVID-19.

Methods

We analyzed data from 1216 adults in the March 2020 Kaiser Family Foundation ‘Coronavirus Poll’, to determine levels of KAPs across different groups. Univariate and multivariate regression analysis was used to identify predictors of KAPs.

Results

In contrast to White respondents, Non-White respondents were more likely to have low knowledge (58% versus 30%; P < 0.001) and low attitude scores (52% versus 27%; P < 0.001), but high practice scores (81% versus 59%; P < 0.001). By multivariate regression, White race (odds ratio [OR] 3.06; 95% confidence interval [CI]: 1.70–5.50), higher level of education (OR 1.80; 95% CI: 1.46–2.23) and higher income (OR 2.06; 95% CI: 1.58–2.70) were associated with high knowledge of COVID-19. Race, sex, education, income, health insurance status and political views were all associated with KAPs.

Conclusions

Racial and socioeconomic disparity exists in the levels of KAPs related to COVID-19. More work is needed to identify educational tools that tailor to specific racial and socioeconomic groups.

Racial demographics and COVID-19 confirmed cases and deaths: a correlational analysis of 2886 US counties

Background

Recent news reports state that racial minority groups, such as African–Americans, are experiencing a greater COVID-19 burden, as measured by confirmed cases and deaths. Limited racial data is available on a national level.

Methods

We conducted the first nationwide analysis to examine COVID-19 and race on a county level. We obtained datasets on COVID-19 cases and deaths, and racial population totals, by US county. We examined if correlations exist between the racial percentages and percentages of confirmed COVID-19 cases and deaths by county.

Results

A positive correlation existed between percentages of African–Americans living in a county and who have COVID-19 (r = 0.254, P < 0.0001), who have died from COVID-19 (r = 0.268, P < 0.0001), and case mortality (r = 0.055, P = 0.003). Positive correlations also existed between percentages of Asian–Americans living in counties and these factors. Negative correlations existed between percentages of Whites living in counties and these factors.

Conclusions

A weak, albeit very significant, positive relationship exists between the percentage of African–Americans living in a county and the percentage of COVID-19 confirmed cases, confirmed deaths and case mortality in the county. This is in support of many city and statewide analyses, and we urge for targeted resources towards work that further examine these racial associations.

Promoting Mindfulness in African American Communities

African Americans report higher rates of chronic stress compared to non-Hispanic Whites. Consequently, chronic stress contributes to disproportionately higher rates of poor health outcomes among African Americans. Mindfulness meditation is a well-established and studied strategy to reduce stress and potentially improve health outcomes. However, the practice of mindfulness meditation is largely underutilized in African American communities despite its potential health benefits. In this commentary, we will discuss the relevance of mindfulness interventions, limited research available, reasons for low representation, and cultural adaptations for mindfulness meditation in African American communities. We also provide additional strategies to guide future mindfulness research that target African Americans.

Afro-Caribbeans Have a Lower Prevalence of Advanced Colon Neoplasia than African-Americans

BACKGROUND/AIMS

The black population in the USA is a heterogeneous group composed of smaller subgroups from different origins. The definition of black in many colorectal cancer (CRC) risk studies is vague, and differences in CRC risk comparing black subpopulations have not been evaluated. The aim of the study is to compare advanced colorectal neoplasia (ACN) between two subgroups of black populations: African-American (AA) and Afro-Caribbean (AC). A secondary aim was to determine whether there are differences in prevalence of adenomas.

METHODS

This was a retrospective study of 3797 AA and AC patients undergoing first time screening colonoscopy in two different institutions in the USA.

RESULTS

Overall adenoma prevalence was 29.3% for the entire population with 29.5% in AAs and 29.0% in AC with no statistically significant difference between the study groups (AOR: 1.02; 95% CI 0.88-1.18, P = 0.751). However, ACN was significantly higher in the AA group (11.8%) compared to AC (9.0%) (AOR: 1.30, 95% CI 1.02-1.66, P = 0.034). It was observed that AAs had ACN at a higher BMI than AC. After adjusting for BMI/ethnicity interactions, the difference in ACN between both groups became more significant (AOR: 1.93, 95% CI 1.16-3.23, P = 0.012).

CONCLUSIONS

AAs have a higher risk of ACN than AC. Current recommendations to start screening in average-risk AAs at an earlier age may not apply to other black subgroups.

Nine-Year Ethanol Intake Trajectories and Their Association With 15-Year Cognitive Decline Among Black and White Adults

Faster rates of age-related cognitive decline might result in early onset of cognitive impairment and dementia. The relationship between ethanol intake and cognitive decline, although studied extensively, remains poorly understood. Previous studies used single measurements of ethanol, and few were conducted in diverse populations. We assessed the association of 9-year trajectories of ethanol intake (1987-1998) with 15-year rate of decline in cognitive performance from mid- to late life (1996-2013) among 2,169 Black and 8,707 White participants of the US Atherosclerosis Risk in Communities study using multivariable linear regression models. We hypothesized that stable, low to moderate drinking would be associated with lesser 15-year cognitive decline, and stable, heavy drinking with greater 15-year cognitive decline. Stable, low to moderate drinking (for Blacks, adjusted mean difference (MD) = 0.03 (95% confidence interval (CI): -0.13, 0.19); for Whites, adjusted MD = 0.02 (95% CI: -0.05, 0.08)) and stable, heavy drinking (for Blacks, adjusted MD = 0.08 (95% CI: -0.34, 0.50); for Whites, adjusted MD = -0.03 (95% CI: -0.18, 0.11)) in midlife compared with stable never-drinking were not associated with 15-year decline in general cognitive function from mid- to late life. No association was observed for the stable former and "mostly" drinking trajectories with 15-year cognitive decline. Stable low, low to moderate, and stable heavy drinking in midlife are not associated with lesser and greater cognitive decline, respectively, from mid- to late life among Black and White adults.

Physical activity-mediated associations between perceived neighborhood social environment and depressive symptoms among Jackson Heart Study participants

BACKGROUND

Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA.

METHODS

We used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates.

RESULTS

Our participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms.

CONCLUSIONS

We found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.

Perceived partner beliefs about condoms and self-efficacy communication within the context of the theory of gender and power

The theory of gender and power provides a unique framework for understanding condom use by accounting for distinct challenges faced by minority women in particular. This study examined whether self-efficacy about condom use communication (SECC) and perceived partner's beliefs about condom (PPBC) use had an influence on condom use frequency; and whether these associations varied by gender. A sample of 252 African-American college students (101 males and 151 females) completed a confidential online survey assessing SECC, PPBC, and condom use behavior. SECC and PPBC showed significant associations with condom use behavior. Furthermore, there was a gender interaction effect with PPBC on condom use behavior. As PPBC increases toward positive associations about condom use, condom use behavior increased significantly more for females (B = 0.42; p = .02) as compared to males (B = 0.26; p = .19). This study supports the need to teach young women effective communication skills in order for them to accurately assess what their partner thinks about condom-related behaviors; and ultimately not allow partner discouragement to influence their decisions to use condoms. Interventions aimed at reducing risky sexual behavior on predominantly Black college campuses, in particular, may benefit from directly addressing relationship power and focusing on building self-efficacy in communicating condom use.

Psychometrics of the Gratitude Questionnaire-6 in African-Americans at Risk for Cardiovascular Disease

Psychometrics of the Gratitude Questionnaire-6, which measures dispositional gratitude, was originally estimated in healthy college students. The purpose of this study was to examine the scales' factor structure, convergent/divergent validity, and reliability among 298 AA adults at risk for CVD in the community. Analyses were performed using bivariate correlations, exploratory factor analysis, and confirmatory factor analysis. The scale demonstrated acceptable estimates for internal consistency (Cronbach's α = 0.729). Our exploratory factor analysis results yielded a one-factor structure consistent with the original instrument, and the confirmatory factor analysis model was a good fit. Convergent/divergent validity was supported by the association with positive affect (coefficient = 0.482, 95% CI = [0.379, 0.573], spiritual well-being (coefficient = 0.608, 95% CI = [0.519, 0.685], and depressive symptoms (coefficient = -0.378, 95% CI = [-0.475, -0.277]. Findings supported the scale's reliability and convergent/divergent validity among AAs at risk for CVD.

The Impact of Race and Age on Distribution of Metastases in Patients with Prostate Cancer

PURPOSE

We investigated the effect of race and age on the distribution of prostate cancer metastases.

MATERIALS AND METHODS

Records for patients with metastatic prostate cancer were abstracted from the National Inpatient Sample database (2008-2015).

RESULTS

Of 6,963 patients with metastatic prostate cancer 3,881 (72.2%) were Caucasian and 1,494 (27.8%) were African American. Bone metastases were the most common site of metastases in Caucasian and African American patients (83.9% and 87.0%, respectively), followed by distant lymph node metastases in Caucasian (13.9% of Caucasian vs 13.2% of African American), liver metastases in African American (13.8% of African American vs 13.3% of Caucasian) and lung metastases in Caucasian and African American patients (9.3% and 13.1%, respectively). No clinically meaningful differences were recorded in age and race analyses, except for lymph node metastases (61.1% to 23.4% in Caucasian vs 39.0% to 25.1% in African American patients), which decreased with age. Specific single organ metastatic sites, outside of bone and lymph nodes, were low in both racial groups (2.1% or less). The rate of brain metastases was also rare in both racial groups at 1.4% or less, regardless of other metastatic locations. Thoracic metastases, in the absence of bone and abdominal metastases, were present in 1.9% of Caucasian and African American patients.

CONCLUSIONS

The most important finding according to age and race resided in rates of lymph node metastases. Conversely, all other racial and age related differences were subtle. Nonetheless, they are important in the context of planning and/or design of clinical trials. Finally, brain (1.4%) and thoracic (1.9%) metastases affect few patients and routine brain and chest imaging may not be warranted.

Sex Differences in Willingness to Participate in Research Based on Study Risk Level Among a Community Sample of African Americans in North Central Florida

This study examined the association between sex, study risks and willingness to participate in research among a community sample of African Americans. We hypothesized that African American males would be more willing to participate in studies involving both minimal and greater-than-minimal risk. The study sample was recruited through a community engagement program (HealthStreet). Interviewers obtained information on socio-demographic variables and willingness to participate in various research types. We categorized research types into minimal risk and greater- than- minimal risk based on the IRB classification. The study sample comprised 6544 African-Americans; 58.4% were females. About 92.6% of the participants were willing to participate in surveys and 58.1% in research requiring medication use. More males would participate in minimal risk studies requiring review of medical records (males 87.0% vs. females 84.2%, p = 0.0021) and studies involving giving a blood sample (males 84.2% vs. females 81.7%, p = 0.0083). Also, more males would participate in greater than minimal risk studies involving the use of medication (60.5% v. 56.3% p = 0.0007). More males were willing to participate in minimal risk studies (studies involving the review of medical records and giving blood samples) and greater-than-minimal risk study involving the use of medication.

An innovative individual-level caries severity and progression indicator among children

OBJECTIVE

To propose an individual-level indicator of caries severity based on the maximum score generated using the international caries detection and assessment system (ICDAS) and test validity of this individual-level indicator by assessing differences between this proposed indicator and the traditional decayed, missing, and filled surfaces (DMFS or dmfs for primary teeth) index.

METHODS

Data on caries severity were collected using a representative sample of children from Detroit, Michigan, aged less than 6 years (N = 749) examined in 2002-2003 (W1) and 2004-2005 (W2). For each wave, each child was assigned to six caries severity groups based on the maximum ICDAS scores. This individual-level indicator was then compared with the surface-level dental caries measure (dmfs + DMFS). In addition, caries progression between W1 and W2 were assessed using individual-level and tooth surface-level indicators.

RESULTS

Both measures were linearly related, and the relationship was statistically significant (P < 0.001).

CONCLUSION

An individual-level caries progression indicator can be developed that is simple and has the ability to communicate with policymakers and the public the severity and impact of dental caries and it can add value to the conventional presentation of DMF/dmf data.

Eye Examination Recency among African American Older Adults with Chronic Medical Conditions

Background: Pervasive racial and economic inequalities have a disproportionate impact on health care utilization among African Americans. One area where we see such disparities is in the recency of eye examinations among the economically disadvantaged. However, our current understanding of the barriers and facilitators of eye examinations in underserved African-American older adults is limited. Aims: Building on Andersen’s model of health service use and using an exploratory approach; we tested various demographic, social, and health factors that were associated with eye examination among underserved middle-aged and older adults in South Los Angeles. We examined predisposing characteristics, enabling factors, and need-for-care characteristics. Methods: With a cross-sectional design, we conducted this survey on a convenience sample of (n = 740) non-institutionalized African-American older adults who were 55+ years old and residing in South Los Angeles, CA, USA. Data were collected on demographic factors, continuity of care, access to care, self-rated health, chronic medical conditions, and depressive symptoms. The outcome was recency of eye examination. Multivariate regression was used for data analysis. Results: 59% of the participants had received at least one eye examination during the last 12 months. A total of 17% had an eye examination within the last two years. Notably, 26% of diabetic participants did not have an eye examination within the last two years. One out of four participants indicated that, within the last two years, no provider ever recommended that they receive an eye examination. Age, education, continuity of medical care, accessibility of medical care, satisfaction with medical care, providers’ recommendation for eye examination, self-rated health, and a diagnosis of hypertension and diabetes mellitus were predictors of eye examination recency. Overall, our analysis indicates that these enabling factors accounted for most of the variance in the recency of eye examinations. Conclusion: A large proportion of underserved African-American middle-aged and older adults in South Los Angeles do not comply with the recommended annual eye examination. This is, in part, because about one-third of them have not received an eye exam recommendation from their health care providers. However, a wide range of factors such as age, education, continuity of care, satisfaction with access, self-rated health, and a diagnosis of hypertension and diabetes mellitus, also influence whether or not African-American middle-aged and older adults receive an eye examination. Programs should address a wide range of multi-level factors to tackle this health inequality.

Life Course Socioeconomic Status, Allostatic Load, and Kidney Health in Black Americans

BACKGROUND AND OBJECTIVES

Low socioeconomic status confers unfavorable health, but the degree and mechanisms by which life course socioeconomic status affects kidney health is unclear.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We examined the association between cumulative lifetime socioeconomic status and CKD in black Americans in the Jackson Heart Study. We used conditional process analysis to evaluate allostatic load as a potential mediator of this relation. Cumulative lifetime socioeconomic status was an age-standardized z-score, which has 1-SD units by definition, and derived from self-reported childhood socioeconomic status, education, and income at baseline. Allostatic load encompassed 11 baseline biomarkers subsuming neuroendocrine, metabolic, autonomic, and immune physiologic systems. CKD outcomes included prevalent CKD at baseline and eGFR decline and incident CKD over follow-up.

RESULTS

Among 3421 participants at baseline (mean age 55 years [SD 13]; 63% female), cumulative lifetime socioeconomic status ranged from -3.3 to 2.3, and 673 (20%) had prevalent CKD. After multivariable adjustment, lower cumulative lifetime socioeconomic status was associated with greater prevalence of CKD both directly (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.04 to 1.33 per 1 SD and OR, 1.45; 95% CI, 1.15 to 1.83 in lowest versus highest tertile) and via higher allostatic load (OR, 1.09; 95% CI, 1.06 to 1.12 per 1 SD and OR, 1.17; 95% CI, 1.11 to 1.24 in lowest versus highest tertile). After a median follow-up of 8 years (interquartile range, 7-8 years), mean annual eGFR decline was 1 ml/min per 1.73 m² (SD 2), and 254 out of 2043 (12%) participants developed incident CKD. Lower cumulative lifetime socioeconomic status was only indirectly associated with greater CKD incidence (OR, 1.04; 95% CI, 1.01 to 1.07 per 1 SD and OR, 1.08; 95% CI, 1.02 to 1.14 in lowest versus highest tertile) and modestly faster annual eGFR decline, in milliliters per minute (OR, 0.01; 95% CI, 0.00 to 0.02 per 1 SD and OR, 0.02; 95% CI, 0.00 to 0.04 in lowest versus highest tertile), via higher baseline allostatic load.

CONCLUSIONS

Lower cumulative lifetime socioeconomic status was substantially associated with CKD prevalence but modestly with CKD incidence and eGFR decline via baseline allostatic load.

Expected Surge in Maternal Mortality and Severe Morbidity among African-Americans in the Era of COVID-19 Pandemic

Prior to the COVID-19 pandemic, African-American mothers were three times as likely to die from pregnancy-related causes compared to white mothers. The impact of the pandemic among African-Americans could further worsen the racial disparities in maternal mortality (MM) and severe maternal morbidity (SMM). This study aimed to create a theoretical framework delineating the contributors to an expected rise in maternal mortality (MM) and severe maternal morbidity (SMM) among African-Americans in the era of the COVID-19 pandemic due to preliminary studies suggesting heightened vulnerability of African-Americans to the virus as well as its adverse health effects. Rapid searches were conducted in PubMed and Google to identify published articles on the health determinants of MM and SMM that have been or likely to be disproportionately affected by the pandemic in African-Americans. We identified socioeconomic and health trends determinants that may contribute to future adverse maternal health outcomes. There is a need to intensify advocacy, implement culturally acceptable programs, and formulate policies to address social determinants of health.

Clinical Characteristics of Multiple Sclerosis in African-Americans

PURPOSE OF REVIEW

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that affects nearly 1 million people in the USA and has the potential to profoundly affect physical ability and income potential at a young age. Since a landmark paper was published in 2014, few studies have looked at differences in MS disease characteristics between African-American and Caucasian patients.

RECENT FINDINGS

African-American patients often have a more severe MS disease course, as well as biomarker data which can portend a worse prognosis. While the sample sizes are usually quite small, subgroup analyses of African-American patients have been performed to evaluate efficacy of disease-modifying treatments as compared with the entire study population, made up of primarily Caucasians. In an era where we strive for personalized medicine, understanding racial differences in MS may help us better treat African-American patients in the future.

Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

BACKGROUND

Although psychosocial and health factors impact insomnia symptoms, less is known about these effects in economically disadvantaged African-American older adults.

AIMS

This study investigated social and health determinants of insomnia symptoms among economically disadvantaged African-American older adults.

METHODS

This survey enrolled 398 African-American older adults (age ≥ 65 years) from economically disadvantaged areas of South Los Angeles. Gender, age, educational attainment, financial difficulty, number of chronic diseases, self-rated health, pain intensity, and depression were covariates. Total insomnia, insomnia symptoms, and insomnia impact were our outcomes. Linear regression was applied for data analysis.

RESULTS

Based on linear regression, higher financial difficulty (B = 0.48, 95% CI = 0.35-0.61), smoking status (B = 1.64, 95% CI = 0.13-3.16), higher pain intensity (B = 0.39, 95% CI = 0.11-0.67), higher number of chronic diseases (B = 0.34, 95% CI = 0.05-0.64), and more depressive symptoms (B = 0.35, 95% CI = 0.12-0.57) were associated with a higher frequency of insomnia symptoms. Based on a logistic regression model, lower age (B = 0.91, 95% CI = 0.91-1.00) and high financial difficulty (OR = 1.15, 95% CI = 1.08-1.24), pain (OR = 2.08, 95% CI = 1.14-3.80), chronic disease (OR = 1.27, 95% CI = 1.07-1.51) and depression (OR = 2.38, 95% CI = 1.22-4.65) were associated with higher odds of possible clinical insomnia. We also found specific predictors for insomnia symptoms and insomnia impact.

CONCLUSIONS

Among African-American older adults in economically disadvantaged areas of South Los Angeles, insomnia symptoms co-occur with other economic, physical, and mental health challenges such as financial difficulty, smoking, multimorbidity, pain, and depression. There is a need to address sleep as a component of care of economically disadvantaged African-American older adults who have multiple social and health challenges.

Addressing Cardiovascular Health Disparities in Minnesota: Establishment of a Community Steering Committee by FAITH! (Fostering African-American Improvement in Total Health)

Despite its rank as the fourth healthiest state in the United States, Minnesota has clear cardiovascular disease disparities between African-Americans and whites. Culturally-tailored interventions implemented using community-based participatory research (CBPR) principles have been vital to improving health and wellness among African-Americans. This paper delineates the establishment, impact, and lessons learned from the formation of a community steering committee (CSC) to guide the Fostering African-American Improvement in Total Health (FAITH!) Program, a CBPR cardiovascular health promotion initiative among African-Americans in Minnesota. The theory-informed CSC implementation process included three phases: (1) Membership Formation and Recruitment, (2) Engagement, and (3) Covenant Development and Empowerment. The CSC is comprised of ten diverse community members guided by mutually agreed upon bylaws in their commitment to FAITH!. Overall, members considered the CSC implementation process effective and productive. A CBPR conceptual model provided an outline of proximal and distal goals for the CSC and FAITH!. The CSC implementation process yielded four lessons learned: (1) Have clarity of purpose and vision, (2) cultivate group cohesion, (3) employ consistent review of CBPR tenets, and (4) expect the unexpected. A robust CSC was established and was instrumental to the success and impact of FAITH! within African-American communities in Minnesota.

Assessing endometrial cancer risk among US women: long-term trends using hysterectomy-adjusted analysis

BACKGROUND

Commonly reported incidence rates for endometrial cancer fail to take into account both the large number of hysterectomies performed each year and the dynamic change in hysterectomy rate over the past decade. Large racial differences in premenopausal hysterectomy rates between Black and White women in the United States likely affect calculation of race-based risk.

OBJECTIVES

The objectives of the study were to determine how the long-term trends in Black-White differences in endometrial cancer incidence and histology type have changed over time for women at risk.

STUDY DESIGN

Using longitudinal Surveillance, Epidemiology, and End Results data from 1997 to 2014 and state-level hysterectomy prevalence from the Behavioral Risk Factor Surveillance System, we calculated hysterectomy-adjusted incidence rates of endometrial cancer and the proportion of high vs low-risk endometrial cancer, by race, over time.

RESULTS

In women older than 50 years who have not had a hysterectomy, endometrial cancer incidence is 87 per 100,000 from 1997 to 2014. Among White women endometrial cancer incidence changed from 102 (1997-2001) to 86 (2012-2014) cases per 100,000, with a nonsignificant decreasing linear trend (adjusted risk ratio, 0.95; 95% confidence interval, 0.91-1.00; p=0.05). In contrast, incidence for Black women was 88 (1997-2001), 101 (2002-2006), 100 (2007-2011), and 102 (2012-2014) cases per 100,000 with no decreasing trend (adjusted risk ratio, 1.02; 95% confidence interval, 0.96-1.10, P = .449). High-risk histology increased among both groups (White: adjusted risk ratio, 1.06; 95% confidence interval, 1.01-1.11; P = .015; Black: adjusted risk ratio, 1.06; 95% confidence interval, 1.02-1.10, P = .007). Racial difference in the proportion of high-risk disease remained stable.

CONCLUSION

Updated hysterectomy-adjusted incidence demonstrates that endometrial cancer is the second most common cancer among women older than 50 years with a uterus and that endometrial cancer has been more common among Black women compared with White women in the United States since 2002. A clinical approach of proactive communication and routine screening for early symptoms in the perimenopausal and menopausal years, especially among Black women, is warranted. These findings can also inform equitable distribution of research funding for endometrial cancer and serve to promote public awareness of this common cancer.

Unequal Protective Effects of Parental Educational Attainment on the Body Mass Index of Black and White Youth

BACKGROUND

Parental educational attainment is shown to be protective against health problems; the Minorities' Diminished Returns theory, however, posits that these protective effects tend to be smaller for socially marginalized groups particularly blacks than whites.

AIMS

To explore racial differences in the effect of parental educational attainment on body mass index (BMI) in a national sample of US adolescents.

METHODS

In this cross-sectional study, we used baseline data of 10,701 (8678 white and 2023 black) 12-17 years old adolescents in the Population Assessment of Tobacco and Health (PATH; 2013). Parental educational attainment was the predictor. Youth BMI (based on self-reported weight and height) was the dependent variable. Age, gender, ethnicity, and family structure were covariates. Race was the focal moderator.

RESULTS

Overall, higher parental educational attainment was associated with lower youth BMI. Race, however, moderated the effect of parental educational attainment on BMI, suggesting that the protective effect of parental educational attainment on BMI is significantly smaller for black than white youth.

CONCLUSIONS

In the United States, race alters the health gains that are expected to follow parental educational attainment. While white youth who are from highly educated families are fit, black youth have high BMI at all levels of parental educational attainment. This means, while the most socially privileged group, whites, gain the most health from their parental education, blacks, the least privileged group, gain the least. Economic, social, public, and health policymakers should be aware that health disparities are not all due to lower socioeconomic status (SES) of the disadvantaged group but also diminished returns of SES resources for them. Black-white health disparities exist across all high socioeconomic status (SES) levels.

Community Empowerment Partners (CEPs): A Breast Health Education Program for African-American Women

Peer educators have been shown to provide effective interventions in breast cancer screening. Few studies have compared the effects of peer education on breast cancer knowledge among peer educators and the community members who are subsequently reached through the peer education. Further, little is known as to whether those who received the education then go on to educate others in the community. The purpose of this study is to address those gaps. Using a pre- and post-test study design, we trained peer educators, provided the educators with resources to train community members, and assessed changes in knowledge. We sought to train ten educators and recommended each train ten community members in breast cancer knowledge and screening strategies. A total of 14 peer educators were trained, who subsequently trained a total of 121 community members, of whom 94 were African American women. Peer educators and community members, showed comparable increases in knowledge. Community members who were educated also increased intention to discuss breast cancer and breast cancer screening with their family, friends, and acquaintances. Our study suggests that it is feasible to train peer educators to increase knowledge among community members to the same level that they themselves experience when trained. Further, community members are interested in sharing information learned related to how much they learn from peer educators.

Police Interactions and the Mental Health of Black Americans: a Systematic Review

Black Americans comprise 13% of the US population, yet data suggests that they represent 23% of those fatally shot by police officers. Data on non-lethal encounters with police in the Black community is less available but can understandably result in emotional trauma, stress responses, and depressive symptoms. The aim of this systematic literature review is to assess if interactions with the police are associated with mental health outcomes among Black Americans. Following pre-defined inclusion criteria, 11 articles were reviewed. Using a quality assessment tool, eight studies received a fair quality rating, two studies a poor rating, and one study received a good rating. The types of police interaction reported among study participants included police use of force during arrest, police stops, police searches, exposure to police killings, and interactions with police in the court system and varied mental health outcomes. Most of the studies (6 of 11) reviewed found statistically significant associations between police interactions and mental health (psychotic experiences, psychological distress, depression, PTSD, anxiety, suicidal ideation and attempts), indicating a nearly twofold higher prevalence of poor mental health among those reporting a prior police interaction compared to those with no interaction. Although better quality studies are needed, findings suggest an association between police interactions and negative mental health outcomes. Changes in law enforcement policy, development and implementation of a validated instrument for police experiences, improved community outreach, a federally mandated review of policy and practice in police departments, and expanded police training initiatives could reduce the potential negative mental health impact of police interactions on Black Americans.

Parental Educational Attainment and Chronic Medical Conditions among American Youth; Minorities' Diminished Returns

Background: Parental educational attainment is protective against chronic medical conditions (CMCs). According to the minorities’ diminished returns (MDRs) theory, however, the health effects of socioeconomic status (SES) indicators are smaller for socially marginalized groups such as racial and ethnic minorities rather than Whites. Aims: To explore racial and ethnic differences in the effect of parental educational attainment on CMCs in a nationally representative sample of American youth. Methods: In this cross-sectional study, we used baseline data of 10,701 12–17 years old youth in the Population Assessment of Tobacco and Health (PATH; 2013). Parental educational attainment was the independent variable. The dependent variable was the number of CMCs in youth. Age, gender, and family structure were covariates. Race and ethnicity were the focal moderators. Linear and multinomial regression were applied to analyze the data. Results: Overall, higher parental educational attainment was associated with a lower number of CMCs. Race and ethnicity, however, showed significant interactions with parental educational attainment on a number of CMCs as well as 2+ CMCs, suggesting that the effect of parenting educational attainment on CMCs is significantly smaller for Black and Hispanic than White youth. Conclusions: In the United States, race and ethnicity alter the health gains that are expected to follow parental educational attainment. While White youth who are from highly educated families are most healthy, Black and Hispanic youth from highly educated families remain at higher risk for CMCs. That means, while the most socially privileged group, Whites, gain the most health from their parental education, Blacks and Hispanics, the least privileged groups, gain the least. The result is a disproportionately high number of CMCs in middle-class Blacks and Hispanics. Economic, social, public, and health policy makers should be aware that health disparities are not all due to lower SES of the disadvantaged group but also diminished returns of SES resources for them. Youth physical health disparities due to race and ethnicity exist across all SES levels.

Reducing cardiovascular disease in a rural community

In this case report, we describe the one-year formative phase of a five-year study to develop, implement, and test a community health worker (CHW)-delivered cardiovascular disease (CVD) prevention intervention. The purpose of the formative phase was to engage community partners in the adaptation of an existing evidence-based CVD prevention intervention to fit the needs and preferences of a rural, predominantly African-American community. The formative work was guided by a framework for adapting evidence-based interventions and involved engaging stakeholders in assessing the intervention's fit with the local context and then applying assessment findings to iteratively adapt the intervention's contents, materials, and delivery methods. Findings from the formative work were then applied to develop CHW position descriptions, workflow diagrams, and a training plan. Findings also were applied to adapt intervention materials and protocols to fit the needs of the community. This case report illustrates how community-engaged formative work can be applied to adapt an evidence-based intervention to fit community needs and resources.

Sexual Orientation, Religious Coping, and Drug Use in a Sample of HIV-Infected African-American Men Living in the Southern USA

Religiosity and spirituality are associated with reduced drug use in the general population, but it is unclear whether this relationship generalizes to sexual minorities. This study investigated the relationship between religious coping, drug use, and sexual orientation in a sample of HIV-infected African-American men (40 heterosexuals; 64 sexual minorities). Most participants (76%) reported being "moderately" or "very" religious. We found no main effect of religious coping or sexual orientation on frequency of drug use. However, there was an interaction between positive religious coping and sexual orientation. Among heterosexuals, positive religious coping was inversely associated with frequency of drug use. However, this relationship was not significant among sexual minorities. Findings suggest HIV-infected African-American sexual minorities living in the South may need additional coping resources to decrease vulnerability to drug use.

Association between General Sense of Mastery and Income in White- and African-American Adults

BACKGROUND

Some research has shown that general sense of mastery (i.e., sense of control over the forces that impact one's life) does not have universal causes and consequences in racial groups. For instance, sense of mastery better predicts depression and mortality for non-Hispanic Whites (NHWs) than that of African-Americans (AAs).

OBJECTIVES

The objective of this study was to test the heterogeneity in the association between the sense of mastery and income by race in a nationally representative sample of NHW and AA adults.

METHODS

This study included a total of 3570 AA and 891 NHW adults who were enrolled to the National Survey of American Life. Variables included race/ethnicity, age, gender, socioeconomic status (SES and household income), and sense of mastery. Linear regression models were applied in the overall sample and also by race.

RESULTS

Overall, high sense of mastery was associated with high household income. In race-specific models, higher levels of sense of mastery were associated with high household income in AAs but not NHWs.

CONCLUSIONS

Racial differences exist in how sense of mastery and income are correlated. It is not clear whether high income generates more sense of mastery for AAs or high sense of mastery is more essential for generating high income for AAs. Policy-makers and clinicians should be aware that SES and sense of mastery are differently linked in AAs and NHWs.

Church-Based Social Support's Impact on African-Americans' Physical Activity and Diet Varies by Support Type and Source

The objective of this study was to examine sources (friends, family, church members, and pastors) and type (positive or negative) of social support and their association with eating and physical activity behaviors. Study participants consisted of 41 African-American adults (78% female), with an average age of 43.5 years (standard deviation = 15.7). Participants were recruited from churches in southwest, Ohio. Mean comparisons showed family members, and friends had the highest positive and negative social support scores for healthy eating and physical activity. Pastors and church members received the lowest social support scores related to these behaviors. Using a linear regression analysis, social support in the form of physical activity rewards from family members was positively associated with fruit and vegetable consumption after adjusting for gender, age, education level, and church location. Based on these findings, future research should continue examining how different social support sources and types influence physical activity and healthy eating behaviors among African-Americans.

Exploring Racial Disparities in Physical Activity and Quality of Life Through an Expectancy-Value Perspective

OBJECTIVES

Alleviating racial/ethnic disparities in physical activity (PA) and health outcomes during childhood becomes an important public health priority as the nation's populace continues to diversify. Guided by expectancy-value model, the purposes of this study were (a) to examine the potential differences in expectancy-value beliefs, PA and health-related quality of life (HRQOL) between African-American (AA) children and their American-Caucasian (AC) peers, and (b) to determine how the relationships among these variables might differ between the two racial groups.

METHOD

Participants were 321 (152 boys; 189 AC) children from three schools who completed a previously validated questionnaire assessing their expectancy-value beliefs in physical education, leisure-time PA (PAQ-C), and HRQOL.

RESULTS

Students' PA was positively associated with HRQOL among AC and AA children (p < .01). AA children had significant higher expectancy-value beliefs but lower HRQOL than AC children. The regression results revealed that both racial groups had a nearly identical effect of expectancy beliefs on their self-reported PA (β = .34 in AA group, β = .33 in AC group, respectively). The regression analysis also suggests that expectancy-value belief was a significant predictor of HRQOL while controlling for all other variables (β = .36; p < .001) for the AC group, but not the AA group.

CONCLUSIONS

The growing health disparities across racial/ethnic subgroups are of great public health concern. Thus, this study provided valuable insights regarding how to promote AA children's PA and HRQOL through an expectancy-value approach.

Prescription opioid misuse among African-American adults: A rural-urban comparison of prevalence and risk

BACKGROUND

Prescription opioid misuse (POM) remains a public health concern in the United States. Although the problem has been studied extensively, little research attention is paid to POM among African-Americans (AAs), and even fewer studies consider rural status in their analysis. The goal of this study, therefore, was to identify and compare prevalence and predictors of POM among rural and urban AA adults using data from a nationally representative sample.

METHODS

Using pooled data across five years (2012-2016) of the National Survey on Drug Use and Health, multivariate logistic regression models were estimated to determine which factors were associated with POM among AA adults.

RESULTS

Findings show that urban and rural AAs have comparable prevalence rates of POM, which is somewhat surprising given that POM often varies based on rural status. A number of factors (e.g., receiving government assistance, religiosity, smoking tobacco or marijuana, misuse of other prescription medications) were significantly correlated with POM for urban and rural AAs, while others (e.g., being age 50+, graduating high school, visiting an emergency department, being arrested, binge drinking) varied by rural status.

CONCLUSION

Results indicate that AA nonmedical prescription opioid users are not a monolith and have distinct demographic, clinical, and psychosocial profiles based on geographic region. Because AAs have been virtually ignored in the POM literature, our findings are an important step towards understanding POM among this understudied group. These results invite additional investigation into AA POM and encourage researchers to consider rural status in their analysis of POM among AAs.

A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California

Background

Five-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3–5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population.

Methods

In this RCT, 1200 English and Spanish-speaking CKD Stage 3–5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months.

Discussion

At the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients’ knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant.

Trial Registration

ClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.